Basic Information
| Provider Information | |||||||||
| NPI: | 1134861461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROMER | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | MONROE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 TERRY ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404562127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067316865 | ||||||||
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| Practice Location | |||||||||
| Address1: | 607 CLIFTY ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425031765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2022 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.